Practitioner 2011;255 (1736): 13

Children with gynaecological problems benefit from a paediatric service

24 Jan 2011Registered users

The setting up of a paediatric and adolescent gynaecology (PAG) service in a DGH has enabled new pathways of care and the development of best practice, a study in the BJOG concludes. The report from this PAG service makes a case for special training for gynaecologists with an interest in paediatric gynaecology and that girls are seen in a paediatric rather than an adult clinic setting. A total of 800 girls were referred to the PAG service in Kettering General Hospital over a 15-year period between 1994 and 2009. The peak age for referral was bimodal at 4 and 15 years of age. 'Not surprisingly menorrhagia and dysmenorrhoea were common comprising 13% of all referrals with a peak age of 14 years. Only 17% had received any treatment from the GP before referral. Treatments given subsequently included the combined pill, depot provera, mefenamic and tranexamic acid as well as HRT and an IUS. And 5% required diagnostic laparoscopy for possible endometriosis. Other problems included amenorrhoea (primary and secondary), urinary symptoms and incontinence and suspected sexual abuse. This latter category comprised just 3% of the total with an age range of 3 months to 15 years. Sub-specialisation is the order of the day in gynaecology and other hospital specialties. The authors make a strong case that each unit have a consultant with a particular interest in paediatric gynaecology and multidisciplinary links for example with urology, endocrinology and dermatology services.'

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